I 116TH CONGRESS 1ST SESSION H. R. 2895 To provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 22, 2019 Mr. SCHNEIDER (for himself, Mr. BACON, and Ms. FINKENAUER) introduced the following bill; which was referred to the Committee on the Judiciary A BILL To provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Conrad State 30 and 4 Physician Access Reauthorization Act’’. 5 SEC. 2. CONRAD STATE 30 PROGRAM. 6 (a) EXTENSION.—Section 220(c) of the Immigration 7 and Nationality Technical Corrections Act of 1994 (Public 8 Law 103–416; 8 U.S.C. 1182 note) is amended by striking 9 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 2 •HR 2895 IH ‘‘September 30, 2015’’ and inserting ‘‘September 30, 1 2021’’. 2 (b) EFFECTIVE DATE.—The amendment made by 3 subsection (a) shall take effect as if enacted on September 4 30, 2018. 5 SEC. 3. RETAINING PHYSICIANS WHO HAVE PRACTICED IN 6 MEDICALLY UNDERSERVED COMMUNITIES. 7 Section 201(b)(1) of the Immigration and Nationality 8 Act (8 U.S.C. 1151(b)(1)) is amended by adding at the 9 end the following: 10 ‘‘(F)(i) Alien physicians who have completed 11 service requirements of a waiver requested under 12 section 203(b)(2)(B)(ii), including— 13 ‘‘(I) alien physicians who completed such 14 service before the date of the enactment of the 15 Conrad State 30 and Physician Access Act; and 16 ‘‘(II) the spouse or children of an alien 17 physician described in subclause (I). 18 ‘‘(ii) Nothing in this subparagraph may be con- 19 strued— 20 ‘‘(I) to prevent the filing of a petition with 21 the Secretary of Homeland Security for classi- 22 fication under section 204(a) or the filing of an 23 application for adjustment of status under sec- 24 tion 245 by an alien physician described in this 25 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 3 •HR 2895 IH subparagraph before the date by which such 1 alien physician has completed the service de- 2 scribed in section 214(l) or worked full-time as 3 a physician for an aggregate of 5 years at the 4 location identified in the section 214(l) waiver 5 or in an area or areas designated by the Sec- 6 retary of Health and Human Services as having 7 a shortage of health care professionals; or 8 ‘‘(II) to permit the Secretary of Homeland 9 Security to grant a petition or application de- 10 scribed in subclause (I) until the alien has sat- 11 isfied all of the requirements of the waiver re- 12 ceived under section 214(l).’’. 13 SEC. 4. EMPLOYMENT PROTECTIONS FOR PHYSICIANS. 14 (a) EXCEPTIONS TO 2-YEAR FOREIGN RESIDENCY 15 REQUIREMENT.—Section 214(l)(1) of the Immigration 16 and Nationality Act (8 U.S.C. 1184(l)(1)) is amended— 17 (1) in the matter preceding subparagraph (A), 18 by striking ‘‘Attorney General’’ and inserting ‘‘Sec- 19 retary of Homeland Security’’; 20 (2) in subparagraph (A), by striking ‘‘Director 21 of the United States Information Agency’’ and in- 22 serting ‘‘Secretary of State’’; 23 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 4 •HR 2895 IH (3) in subparagraph (B), by inserting ‘‘, except 1 as provided in paragraphs (7) and (8)’’ before the 2 semicolon at the end; 3 (4) in subparagraph (C), by striking clauses (i) 4 and (ii) and inserting the following: 5 ‘‘(i) the alien demonstrates a bona fide 6 offer of full-time employment at a health facil- 7 ity or health care organization, which employ- 8 ment has been determined by the Secretary of 9 Homeland Security to be in the public interest; 10 ‘‘(ii) the alien— 11 ‘‘(I) has accepted employment with 12 the health facility or health care organiza- 13 tion in a geographic area or areas which 14 are designated by the Secretary of Health 15 and Human Services as having a shortage 16 of health care professionals; 17 ‘‘(II) begins employment by the later 18 of the date that is— 19 ‘‘(aa) 120 days after receiving 20 such waiver; 21 ‘‘(bb) 120 days after completing 22 graduate medical education or train- 23 ing under a program approved pursu- 24 ant to section 212(j)(1); or 25 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 5 •HR 2895 IH ‘‘(cc) 120 days after receiving 1 nonimmigrant status or employment 2 authorization, if the alien or the 3 alien’s employer petitions for such 4 nonimmigrant status or employment 5 authorization not later than 120 days 6 after the date on which the alien com- 7 pletes his or her graduate medical 8 education or training under a pro- 9 gram approved pursuant to section 10 212(j)(1); and 11 ‘‘(III) agrees to continue to work for 12 a total of not less than 3 years in the sta- 13 tus authorized for such employment under 14 this subsection, except as provided in para- 15 graph (8).’’; and 16 (5) in subparagraph (D), in the matter pre- 17 ceding clause (i), by inserting ‘‘(except as provided 18 in paragraph (8))’’. 19 (b) ALLOWABLE VISA STATUS FOR PHYSICIANS FUL- 20 FILLING WAIVER REQUIREMENTS IN MEDICALLY UNDER- 21 SERVED AREAS.—Section 214(l)(2)(A) of such Act (8 22 U.S.C. 1184(l)(2)(A)) is amended to read as follows: 23 ‘‘(A) Upon the request of an interested Federal 24 agency or an interested State agency for recommen- 25 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 6 •HR 2895 IH dation of a waiver under this section by a physician 1 who is maintaining valid nonimmigrant status under 2 section 101(a)(15)(J) and a favorable recommenda- 3 tion by the Secretary of State, the Secretary of 4 Homeland Security may change the status of such 5 physician to any status authorized for employment 6 under this Act. The numerical limitations contained 7 in subsection (g)(1)(A) shall not apply to any alien 8 whose status is changed under this subparagraph.’’. 9 (c) VIOLATION OF AGREEMENTS.—Section 10 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 11 amended by inserting ‘‘substantial requirement of an’’ be- 12 fore ‘‘agreement entered into’’. 13 (d) PHYSICIAN EMPLOYMENT IN UNDERSERVED 14 AREAS.—Section 214(l) of such Act (8 U.S.C. 1184(l)), 15 as amended by this section, is further amended by adding 16 at the end the following: 17 ‘‘(4)(A) If an interested State agency denies the ap- 18 plication for a waiver under paragraph (1)(B) from a phy- 19 sician pursuing graduate medical education or training 20 pursuant to section 101(a)(15)(J) because the State has 21 requested the maximum number of waivers permitted for 22 that fiscal year, the physician’s nonimmigrant status shall 23 be extended for up to 6 months if the physician agrees 24 to seek a waiver under this subsection (except for para- 25 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 7 •HR 2895 IH graph (1)(D)(ii)) to work for an employer described in 1 paragraph (1)(C) in a State that has not yet requested 2 the maximum number of waivers. 3 ‘‘(B) Such physician shall be authorized to work only 4 for the employer referred to in subparagraph (A) from the 5 date on which a new waiver application is filed with such 6 State until the earlier of— 7 ‘‘(i) the date on which the Secretary of Home- 8 land Security denies such waiver; or 9 ‘‘(ii) the date on which the Secretary approves 10 an application for change of status under paragraph 11 (2)(A) pursuant to the approval of such waiver.’’. 12 (e) CONTRACT REQUIREMENTS.—Section 214(l) of 13 such Act, as amended by this section, is further amended 14 by adding at the end the following: 15 ‘‘(5) An alien granted a waiver under paragraph 16 (1)(C) shall enter into an employment agreement with the 17 contracting health facility or health care organization 18 that— 19 ‘‘(A) specifies the maximum number of on-call 20 hours per week (which may be a monthly average) 21 that the alien will be expected to be available and 22 the compensation the alien will receive for on-call 23 time; 24 ‘‘(B) specifies— 25 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 8 •HR 2895 IH ‘‘(i) whether the contracting facility or or- 1 ganization will pay the alien’s malpractice in- 2 surance premiums; 3 ‘‘(ii) whether the employer will provide 4 malpractice insurance; and 5 ‘‘(iii) the amount of such insurance that 6 will be provided; 7 ‘‘(C) describes all of the work locations that the 8 alien will work and includes a statement that the 9 contracting facility or organization will not add addi- 10 tional work locations without the approval of the 11 Federal agency or State agency that requested the 12 waiver; and 13 ‘‘(D) does not include a non-compete provision. 14 ‘‘(6) An alien granted a waiver under this subsection 15 whose employment relationship with a health facility or 16 health care organization terminates under paragraph 17 (1)(C)(ii) during the 3-year service period required under 18 paragraph (1) shall be considered to be maintaining lawful 19 status in an authorized period of stay during the 120-day 20 period referred to in items (aa) and (bb) of subclause (III) 21 of paragraph (1)(C)(ii) or the 45-day period referred to 22 in subclause (III)(cc) of such paragraph.’’. 23 (f) RECAPTURING WAIVER SLOTS LOST TO OTHER 24 STATES.—Section 214(l) of such Act, as amended by this 25 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 9 •HR 2895 IH section, is further amended by adding at the end the fol- 1 lowing: 2 ‘‘(7) If a recipient of a waiver under this subsection 3 terminates the recipient’s employment with a health facil- 4 ity or health care organization pursuant to paragraph 5 (1)(C)(ii), including termination of employment because of 6 circumstances described in paragraph (1)(C)(ii)(III), and 7 accepts new employment with such a facility or organiza- 8 tion in a different State, the State from which the alien 9 is departing may be accorded an additional waiver by the 10 Secretary of State for use in the fiscal year in which the 11 alien’s employment was terminated.’’. 12 (g) EXCEPTION TO 3-YEAR WORK REQUIREMENT.— 13 Section 214(l) of such Act, as amended by this section, 14 is further amended by adding at the end the following: 15 ‘‘(8) The 3-year work requirement set forth in sub- 16 paragraphs (C) and (D) of paragraph (1) shall not apply 17 if— 18 ‘‘(A)(i) the Secretary of Homeland Security de- 19 termines that extenuating circumstances, including 20 violations by the employer of the employment agree- 21 ment with the alien or of labor and employment 22 laws, exist that justify a lesser period of employment 23 at such facility or organization; and 24 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 10 •HR 2895 IH ‘‘(ii) the alien demonstrates, not later than 120 1 days after the employment termination date (unless 2 the Secretary determines that extenuating cir- 3 cumstances would justify an extension), another 4 bona fide offer of employment at a health facility or 5 health care organization in a geographic area or 6 areas which are designated by the Secretary of 7 Health and Human Services as having a shortage of 8 health care professionals, for the remainder of such 9 3-year period; 10 ‘‘(B)(i) the interested State agency that re- 11 quested the waiver attests that extenuating cir- 12 cumstances, including violations by the employer of 13 the employment agreement with the alien or of labor 14 and employment laws, exist that justify a lesser pe- 15 riod of employment at such facility or organization; 16 and 17 ‘‘(ii) the alien demonstrates, not later than 120 18 days after the employment termination date (unless 19 the Secretary determines that extenuating cir- 20 cumstances would justify an extension), another 21 bona fide offer of employment at a health facility or 22 health care organization in a geographic area or 23 areas which are designated by the Secretary of 24 Health and Human Services as having a shortage of 25 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 11 •HR 2895 IH health care professionals, for the remainder of such 1 3-year period; or 2 ‘‘(C) the alien— 3 ‘‘(i) elects not to pursue a determination of 4 extenuating circumstances pursuant to sub- 5 clause (A) or (B); 6 ‘‘(ii) terminates the alien’s employment re- 7 lationship with the health facility or health care 8 organization at which the alien was employed; 9 ‘‘(iii) demonstrates, not later than 45 days 10 after the employment termination date, another 11 bona fide offer of employment at a health facil- 12 ity or health care organization in a geographic 13 area or areas, in the State that requested the 14 alien’s waiver, which are designated by the Sec- 15 retary of Health and Human Services as having 16 a shortage of health care professionals; and 17 ‘‘(iv) agrees to be employed for the remain- 18 der of such 3-year period, and 1 additional year 19 for each termination under clause (ii).’’. 20 SEC. 5. ALLOTMENT OF CONRAD 30 WAIVERS. 21 (a) IN GENERAL.—Section 214(l) of the Immigration 22 and Nationality Act (8 U.S.C. 1184(l)), as amended by 23 section 4, is further amended by adding at the end the 24 following: 25 VerDate Sep 11 2014 05:53 Jun 06, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2895.IH H2895 kjohnson on DSK79L0C42 with BILLS 12 •HR 2895 IH ‘‘(8)(A)(i) All States shall be allotted a total of 35 1 waivers under paragraph (1)(B) for a fiscal year if 90 per- 2 cent of the waivers available to the States receiving at 3 least 5 waivers were used in the previous fiscal year. 4 ‘‘(ii) When an allotment occurs under clause (i), all 5 States shall be allotted an additional 5 waivers under 6 paragraph (1)(B) for each subsequent fiscal year if 90 7 percent of the waivers available to the States receiving at 8 least 5 waivers were used in the previous fiscal [Text truncated for display. Full text available on Congress.gov.]